Provider Demographics
NPI:1699889576
Name:UNIVERSITY OF UTAH
Entity type:Organization
Organization Name:UNIVERSITY OF UTAH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-587-6760
Mailing Address - Street 1:PO BOX 511258
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-7813
Mailing Address - Country:US
Mailing Address - Phone:801-587-6760
Mailing Address - Fax:801-587-6675
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0100
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-HOSP-208273R00000X
UT2006-HOSP208273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1588656870OtherU HOSPITAL MAIN NPI NUMBR
UT1588656870OtherU HOSPITAL MAIN NPI NUMBR